Thread by @KirtanPatolia

Hyponatremia in pregnancy has unique multifaceted pathogenesis ⭐✨ ✨⚡

Here is a short 🧵 exploring this intriguing concept

@rabihmgeha @DxRxEdu @CPSolvers @sargsyanz @AnnKumfer @ASanchez_PS @Sharminzi @rav7ks @RosenelliEM @SatyaPatelMD #MedTwitter #Nephpearls

1.) Reset Osmostat

- Common in first 2 months of pregnancy

- Due to altered osmolality set point at which ADH is released

- Usually asymptomatic with 4-5 mEQ drop in Na levels.

- If you see hyponatremia beyond first 3 months of pregnancy, look for other causes.

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2.) Preeclampsia and SIADH

Proteinuria>> Intravascular volume depletion (akin to Cirrhosis, HF)>> nonosmotic stimulus to release ADH

Abnormal placenta>excess release of Oxytocin

Pregnant patients receive Oxytocin and IV fluids for multiple other reasons as well

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3. Placenta releases Vasopressinase (causes Diabetes insipidus like state normally)

Abnormal placenta in preeclampsia can't release Vasopressinase> high ADH

Preeclampsia mediated abnormal angiogenesis leading to placental dysfunction and iatrogenic aspects> low Na

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4. Hyponatremia in pregnancy has relevance for fetus as well.

Fetal Na levels equilibrate rapidly with mother's>> low fetal Na can cause seizures, jaundice, and tachypnea

Reflex suppression of ADH release in the fetus can lead to polyhydramnios

Thanks for reading

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